General orthopaedics

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Information about General orthopaedics

Published on March 9, 2014

Author: drzameer


General orthopaedics : General orthopaedics Dr Zameer Ali Senior registrar Orthopaedics SKIMS MCH PowerPoint Presentation: Orthopaedics is concerned with Bones , Joints , M uscles, Tendons and Nerves – the skeletal system and all that makes it move. Conditions that affect these structures fall into seven easily remembered pairs: PowerPoint Presentation: 1. Congenital and developmental abnormalities. 2. Infection and inflammation. 3. Arthritis and rheumatic disorders. 4. Metabolic and endocrine disorders. 5. Tumours and lesions that mimic them. 6. Neurological disorders and muscle weakness. 7. Injury and mechanical derangement. PowerPoint Presentation: Diagnosis in orthopaedics, as in all of medicine, is the identification of disease. It begins from the very first encounter with the patient and is gradually modified and fine-tuned until we have a picture, not only of a pathological process but also of the functional loss and the disability that goes with it HISTORY: H ISTORY ‘Taking a history’ is a misnomer. The patient tells a story ; it is we the listeners who construct a history . Key Words IN HISTORY: Key Words IN HISTORY certain key words and phrases will inevitably stand out: injury, pain, stiffness, swelling, deformity , instability, weakness, altered sensibility and loss of function or inability to do certain things that were easily accomplished before SYMPTOMS : SYMPTOMS Pain Pain is the most common symptom in orthopaedics . Pain severity ranges from inexpressively bland to unbelievably bizarre Severity of pain: Severity of pain The commonest method is to invite the patient to mark the severity on an analogue scale of 1–10, with 1 being mild and easily ignored and 10 being totally unbearable PowerPoint Presentation: Grade I (mild) Pain that can easily be ignored. • Grade II (moderate) Pain that cannot be ignored, interferes with function and needs attention or treatment from time to time PowerPoint Presentation: Grade III (severe) Pain that is present most of the time , demanding constant attention or treatment. Grade IV (excruciating) Totally incapacitating pain . Type Of Pain: Type Of Pain there are clearly differences between the throbbing pain of an abscess and the aching pain of chronic arthritis, between the ‘burning pain’ of neuralgia and the ‘stabbing pain’ of a ruptured tendon. Referred pain : Referred pain Referred pain PowerPoint Presentation: Stiffness Stiffness may be generalized (typically in systemic disorders such as rheumatoid arthritis and ankylosing spondylitis ) or localized to a particular joint PowerPoint Presentation: regular early morning stiffness of many joints is one of the cardinal symptoms of rheumatoid arthritis, whereas transient stiffness of one or two joints after periods of inactivity is typical of osteoarthritis PowerPoint Presentation: Locking of joint suggestive of meniscal tear Swelling may be in the soft tissues, the joint or the bone ; to the patient they are all the same . Deformity: Deformity The common deformities are described by patients in terms such as round shoulders, spinal curvature, knock knees, bow legs, pigeon toes and flat feet. Deformity of a single bone or joint is less easily described and the patient may simply declare that the limb is ‘crooked DEFORMITY: DEFORMITY GENU VALGUM DEFORMITY: DEFORMITY GENU VARUM POSTURE: POSTURE RIGHT WRIST DROP SECONDARY TO RADIAL NERVE PALSY Weakness : Weakness Generalized weakness is a feature of all chronic illness, and any prolonged joint dysfunction will inevitably lead to weakness. Instability: Instability The patient may complain that the joint ‘gives way’ or ‘jumps out of place’. If this happens repeatedly, it suggests abnormal joint laxity, capsular or ligamentous deficiency PAST HISTORY: PAST HISTORY Patients often forget to mention previous illnesses or accidents , or they may simply not appreciate their relevance to the present complaint . twisted ankle ’ ------------- osteoarthritis GI diseases ---------------osteoporosis conjuctivitis , iritis , psoriasis or urogenital disease------------ Rheumatic Disorders PowerPoint Presentation: Patients should also be asked about previous medication : many drugs, and especially cortico - steroids , have long-term effects on bone. Alcohol and drug abuse are important, and we must not be afraid to ask about them. PowerPoint Presentation: PERSONAL HISTORY TREATMENT HISTORY SOCIO ECONOMIC HISTORY ALLERGIC HISTORY Examination: Examination The examination actually begins from the moment we set eyes on the patient . General physical examination CNS/CVS/RESP SYSTEM/GIT GAIT PowerPoint Presentation: When we proceed to the structured examination, the patient must be suitably undressed; no mere rolling up of a trouser leg is sufficient. If one limb is affected , both must be exposed so that they can be compared PowerPoint Presentation: Traditional clinical routine , inspection, palpation, manipulation, NOW replaced by LOOK FEEL MOVE AND MEASURE LOOK: LOOK Shape and posture Skin LOOK: LOOK Look Scars often give clues to the previous history. The faded scar on this patient’s thigh is an old operation scars are due to postoperative infection; one of the sinuses is still draining. FEEL: FEEL Feeling is exploring, not groping aimlessly. Know your anatomy and you will know where to feel for the landmarks ; find the landmarks and you can construct a virtual anatomical picture in your mind FEEL: FEEL SKIN The soft tissues The bones and joints Tenderness TENDERNESS: TENDERNESS MOVE: MOVE Movement’ covers several different activities: Active movement , passive mobility, abnormal or unstable movement , and provocative movement. PowerPoint Presentation: ACTIVE movement PASSIVE movement Provocative movement: Provocative movement Provocative movement One of the most telling clues to diagnosis is reproducing the patient’s symptoms by applying a specific, provocative movement UNSTABLE MOVEMENT: UNSTABLE MOVEMENT Unstable movement This is movement which is inherently unphysiological UNSTABLE MOVEMENTS: UNSTABLE MOVEMENTS PowerPoint Presentation: Words such as ‘full’, ‘good ’, ‘ limited’ and ‘poor’ are misleading. Always cite the range or span, from start to finish, in degrees. For example , ‘knee flexion 0–140°’ SPECIAL TESTS: SPECIAL TESTS Thomas’ test Trendelenburg’s test McMurray’s test for a torn meniscus of the knee , Anterior drawer test Lachman’s test for cruciate ligament instability LOOK FEEL MOVE AND MEASURE: LOOK FEEL MOVE AND MEASURE The sequence may also have to be altered because a patient is in severe pain or disabled: you would not try to move a limb at all in someone with a suspected fracture when an x-ray can provide the answer. MEASUREMENTS: MEASUREMENTS LENGTH OF LIMB LLD (SHORTENING OR LENGTHENING) GIRTH DIAGNOSTIC IMAGING: DIAGNOSTIC IMAGING PLAIN Radiography CT scan MRI DEXA SCAN DOPLER USG Sinogram Arthrography DIAGNOSTIC IMAGING: DIAGNOSTIC IMAGING Sinography : Sinography is the simplest form of contrast radio - graphy . The medium (usually one of the ionic watersoluble compounds ) is injected into an open sinus; the film shows the track and whether or not it leads to the underlying bone or joint Note small popliteal cyst: Note small popliteal cyst Contrast arthrography knee Arthrography: Arthrography is a particularly useful form of contrast radiography. Intra-articular loose bodies will produce filling defects in the opaque contrast medium ORTHOPAEDIC RADOIOGRAPHY: ORTHOPAEDIC RADOIOGRAPHY cartilage-capped exostosis (osteochondroma) is confirmed by the x-rays.:  cartilage-capped exostosis ( osteochondroma ) is confirmed by the x-rays. PowerPoint Presentation: NORMAL HIP EARLY PowerPoint Presentation: ADVANCED OA THR MMT: MMT MRI KNEE MRI PICTURE OF TORN MENISCUS BMD: BMD COMPRESSION FRACTURE DXA SCAN

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